Surgical versus Nonsurgical Treatment for Cervical Radiculopathy

Area of Science:

• Neurosurgery
• Orthopedics
• Physical Medicine and Rehabilitation

Background:

• Cervical radiculopathy, often caused by disc herniation or spondylosis, presents a treatment challenge.
• Limited comparative trials exist for surgical versus nonsurgical interventions.

Purpose of the Study:

• To compare the efficacy of surgical versus nonsurgical treatments for cervical radiculopathy.
• To evaluate outcomes based on the cause of radiculopathy: disc herniation or spondylosis.

Main Methods:

• Two randomized clinical trials involving 180 patients with disabling radicular arm pain.
• Patients were assigned to either anterior cervical discectomy and fusion or a nonsurgical approach (physician and physical therapy support).
• The primary outcome measure was the Neck Disability Index (NDI) at 12 months.

Main Results:

• In the disc herniation trial, surgical treatment showed a statistically significant improvement in NDI scores at 12 months (mean difference 7.4, P=0.01).
• In the spondylosis trial, no significant difference in NDI scores was observed between surgical and nonsurgical groups (mean difference 2.3, P=0.52).
• Higher crossover rates to surgery were observed in the spondylosis nonsurgical group.

Conclusions:

• Surgical intervention is more effective than nonsurgical treatment for cervical radiculopathy due to disc herniation.
• Surgical versus nonsurgical treatment yields similar outcomes for cervical radiculopathy caused by spondylosis.
• These findings aid in guiding treatment decisions for cervical radiculopathy based on etiology.